National Practitioner Data Bank

On behalf of Brian Quinn of The Law Offices of Brian E. Quinn posted in Medical Licensing on Thursday, October 17, 2013.

State Board Action can have a permanent and drastic effect on a physician, dentist, nurse, or other health care practitioner's license. The National Practitioner Data Bank collects and discloses negative information on health care practitioners, including malpractice awards, loss of license or exclusion from participation in Medicare or Medicaid. [1]

The Boards of Medical Examiners and States are required to report certain actions taken against health care practitioners. The National Practitioner Data Bank (NPDB) was created by Congress with the primary goals of improving health car quality protecting the public, and reducing fraud. The NPDB is statutorily mandated at 42 U.S.C. 11101-11152 and administered at Title 45 of the Federal Regulations. Title 45 Part 60, Sections §60.8 and §60.9 implements the reporting requirements to the National Practitioner's Data Bank (NPDB). Information reported to NPDB is maintained permanently unless it is corrected or voided from the system. Sections 60.8 and 60.9 state:

§60.8 Reporting licensure actions taken by Boards of Medical Examiners

(a) What action must be reported. Each Board of Medical Examiners must report to the NPDB any action based on reasons relating to a physician's or dentist's professional competence or professional conduct:

(2) Which censures, reprimands or places on probation a physician or dentist, or

(3) Under which a physician's license is surrendered.

§60.9 Reporting licensure and certification actions taken by states

(a) What action must be reported. Each state is required to adopt a system of reporting to the NPDB actions, as listed below, which are taken against a health care practitioner, health care entity, provider, or supplier ( all as defined in § 60.3 of this part). The actions taken must be as a result of formal proceedings (as defined in § 60.3). The actions which must be reported are:

(1) Any adverse action taken by the licensing or certification authority of the state as a result of a formal proceeding, including revocation of suspension of a license, or certification agreement or contract for participation in a government health care program (and the length of any such suspension) reprimand, censure, or probation;

(2) Any dismissal or closure of the formal proceeding by reason of the health care practitioner, health care entity, provider, or supplier surrendering the license or certification agreement or contract for participation in a government health care program, or leaving the state or jurisdiction;

(3) Any other loss license or loss of the certification agreement or contract for participation in a government health care program, or the right to apply for, or renew, a license or certification agreement or contract of the health care practitioner, health care entity, provider or supplier, whether by operation of law, voluntary surrender, nonrenewal (excluding non-renewals due to nonpayment of fees, retirement, or change to inactive status) or otherwise;

(4) Any negative action or finding by such authority, organization, or entity regarding the health care practitioner, health care entity, provider or supplier.

Both §60.8 and §60.9 require personal background and demographic information Section 60.8 requires a description of the Board action, the date the action was taken, its effective date and duration. (Section 60.8 (b) (10)); Section 60.9 (1)(b)(4) i,ii,iii requires (i) a narrative description of the acts or omissions and injuries upon which the reported action was based; (ii) Classification of the acts or omissions in accordance with a reporting code adopted by the Secretary; and (iii) Classification of the action taken in accordance with a reporting code adopted by the Secretary, and the amount of any monetary penalty resulting from the reported action.

Disciplinary action before the State Medical Board can result in a permanent entry with the National Practitioner Data Bank. The entry can have a profound effect on the practitioner's ability to maintain employment. We have been representing physicians, dentists and other healthcare providers before the various State Boards. We can protect your rights to help to avoid the negative and permanent effect of a report to the National Practitioner Data Bank.

(Prior to May 6, 2013, the Data Bank comprised the National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank. The two were consolidated by Section 6403 of the Affordable Care Act of 2012, Public Law 111-148).

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